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H. C. Beck, C. G. V. De Moraes, T. S. Prata, F. A. Folgar, K. Ahrlich, C. C. Teng, R. Ritch, C. Tello, J. M. Liebmann; Recurrent Disc Hemorrhage Does Not Increase the Rate of Visual Field Progression. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5835.
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We evaluated disc photographs of glaucoma patients with ≥5 SITA-Standard 24-2 fields in either eye for the presence and location of DH. Group A had patients with one single detected DH in one eye, and Group B had >1 DH detected in the same eye during follow-up. Pointwise linear regression analysis (Progressor®) was used to calculate rates of progression after DH detection. Exclusion criteria included insufficient VFs to create a slope after DH detection and other ocular conditions likely to affect the VF. Patient demographics, ocular characteristics, and systemic conditions and medications were evaluated.
56 patients were enrolled (Group A=40, Group B=16). The mean number of VFs following the initial DH was 9.2±4.4, and mean follow up was similar (Group A, 7.3±4.2 vs Group B 7.6±4.1 yrs, p=0.80). Patients with recurrent DH had less baseline VF damage (-2.75±4.0 vs -5.6±5.0 dB, p<0.01). However, the rate of progression was similar (0.86±0.8 (Group A) vs 0.67±1.0 (Group B) dB/yr, p=0.38). When we adjusted the rates of progression to the baseline MD (general linear model), the difference remained not significant (p=0.61). Age (69.3±12.0 vs 68.2±9.9, p=0.68), female gender (70% vs 50%, p=0.30), CCT (544.1±45.6 vs 543.4±56.6 µm, p=0.74), baseline IOP (16.1±4.0 vs 17.6±4.0, p=0.30), mean IOP post-DH (14.7±2.7 vs 15.3±2.3,p=0.48), prevalence of systemic hypertension (52.5% vs 50%, p=0.40), hypercholesterolemia (32.5% vs 21.4%,p=0.21), and use of ASA/anticoagulation (30% vs 35.7%, p=0.70) were not different between groups. Recurrent DH occurred within 2 clock hours of the initial DH in 88% (14/16) of cases, and in the hemifield with less damage in 75% (12/16).
Recurrent DH does not result in a faster rate of VF progression and occurs more often in eyes with the less VF damage at baseline, corroborating previous findings that hemorrhages are less likely to occur in areas with significant rim loss.Disclosures: None.Support: Edith C. Blum Foundation Fund and the New York Glaucoma Research Institute, NY, NY.
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